Dialysate aluminium concentration and renal bone disease

Area of Science:

• Nephrology
• Bone Metabolism
• Toxicology

Background:

• Renal bone disease is a common complication in patients undergoing regular hemodialysis.
• Aluminum accumulation is a potential concern in patients with chronic kidney disease.

Purpose of the Study:

• To investigate the relationship between aluminum exposure and renal bone disease in hemodialysis patients.
• To assess the impact of dialysate aluminum concentrations on fracture incidence and bone histology.

Main Methods:

• Study included 40 patients on regular hemodialysis.
• Radiology and quantitative bone histology were used to evaluate bone health.
• Analysis correlated dialysate aluminum levels with clinical and histological findings.

Main Results:

• Fractures were significantly more frequent in patients with high dialysate aluminum exposure.
• Histologic indices of osteomalacia correlated positively with prevailing dialysate aluminum concentration.
• Higher aluminum exposure was associated with lower plasma phosphate and hypercalcemia in some patients with osteomalacia.

Conclusions:

• Aluminum appears to be a toxic agent contributing to mineralizing defects in the bone of renal failure patients.
• Aluminum toxicity may explain the suboptimal response of some renal osteomalacia patients to 1,25-dihydroxy vitamin D therapy.